tbuckley/cabot-search huggingface dataset:
Abstract 311: Performance of Video-assisted Cardiac Arrest Recognition Protocol for Emergency Medical Dispatch in Out-of-hospital Cardiac Arrest
Authors: Tae Han Kim, Kyoung J Song, Kijeong Hong, Stephen Gyung Won G LEE, seul ki choi, Ki Hong Kim
Journal: Circulation (2022)

Introduction: Cardiac arrest recognition in emergency medical dispatch (EMD) is an important process for initiation of telephone CPR that could lead to bystander CPR before emergency medical service (EMS) arrival. Video-assisted protocol was developed and implemented for better recognition of cardiac arrest suspected calls that recognition was uncertain under conventional audio-call dispatch. We tested the performance of video-assisted protocol after pilot implementation in a dispatch center. Methods: All emergency medical dispatch calls received by Seoul emergency dispatch center that used video-assisted recognition protocol from Jun. 2020 to Dec. 2020 were enrolled. The primary outcome was the presence of cardiac arrest at EMS arrival evaluated by EMS providers arrived at the scene. The predictive performance measure of video-assisted protocol was calculated including sensitivity and specificity with 95% confidence interval (CI). Result: During the study period, video-assisted protocol was used in 115 emergency calls that dispatchers were uncertain during initial audio-call. In 15 cases the dispatcher additionally recognized the case as cardiac arrest under video-assistance. Of recognized cases, 14 (93.3%) cases were cardiac arrest when EMS arrived at scene. The sensitivity (95% CI) and the specificity (95% CI) of video-assistance protocol were 63.6% (40.7 - 82.8) and 98.9% (94.2 - 100) respectively. Conclusion: Use of video-assisted protocol helped recognizing additional cardiac arrest cases that could not be recognized with the audio-call in the dispatch center. Technological and operational improvement should be continuously studied for better cardiac arrest recognition using video-assisted protocol during emergency call taking.
Abstract 282: Extracorporeal Resuscitation For Out-of-Hospital Cardiac Arrest Patients: Analysis By Time-Dependent Propensity Score Matching Using Nationwide Database In Japan
Authors: Yohei Okada, Sho Komukai, Norihiro Nishioka, Takeyuki Kiguchi, Tetsuhisa Kitamura, Taku Iwami
Journal: Circulation (2022)

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has been focused as a rescue therapy for the refractory cardiac arrest patients; however, little is known about the effect of ECPR on survival. The aim of this study is to evaluate the association between ECPR and the survival among the out-of-hospital cardiac arrest patients. Method: This was the secondary analysis of JAAM-OHCA registry which is a nationwide multicenter prospective study collecting the data of out-of-hospital cardiac arrest patients from July 2012 to December 2019. The study participant were adult (≥18 years) cardiac arrest patients due to internal medical cause. Initial cardiac rhythm was stratified as initial shockable and non-shockable rhythm. Patients received ECPR were sequentially matched with the patients who had not yet received within the same minutes (control) based on the time-dependent propensity scores calculated from the patient characteristics to eliminate the resuscitation time bias. Odds ratio with 95% confidence interval (CI) of ECPR for the 30-day survival were calculated by conditional logistic model. Results: Of 57,754 patients in the JAAM-OHCA registry, 1,826 matched cohort with initial shockable rhythm (913 treated with ECPR and 913 control) and 740 matched cohort with initial non-shockable rhythm (370 treated with ECPR and 370 control) were eligible for analysis. Their characteristics between with ECPR and control were well balanced. In the matched cohort with initial shockable rhythm, 30-day survival was 24.6% (225/913) in the patients with ECPR and 16.3% (149/913) in the control. In the matched cohort with initial non-shockable rhythm, 30-day survival was 11.9% (44/370) in the patients with ECPR and 2.4% (9/370) in the control. Odds ratio of with ECPR for 30-day survival was 1.76 [95%CI: 1.38-2.25] in shockable rhythm and 5.37 [95%CI: 2.53- 11.43] in non-shockable rhythm, referred to the control. Conclusion: This time-dependent propensity score sequential matching analysis suggested that ECPR was associated with the 30-day survival outcomes among the out-of-hospital cardiac arrest patients with both initial shockable and non-shockable rhythms.
Abstract 9464: Adipocyte-Derived Fatty-Acid-Binding Protein 4 Impairs Human Dermal Microvascular Endothelial Cells Under Hypoxia Insults - A Mechanistic Clue to Impaired Wound Healing in Obesity
Authors: Yen-Wen Wu, Jaw W Chen, Ting-Ting Chang
Journal: Circulation (2022)

Introduction: Dermal white adipose tissue is found in the dermis of the skin, which may participate in the wound healing process. Obesity-mediated adipocyte hypertrophy has been related to adipose tissue hypoxia and chronic low-grade inflammation, which may impair wound healing by suppressing the vascularity. Fatty-acid-binding protein (FABP) 4 is a cytosolic fatty acid chaperone expressed in adipocytes, which may be involved in the pathogenesis of some vascular diseases and was found upregulated in skin tissue of obese animals. This study aimed to investigate the potential mechanistic impacts of adipocyte-derived FABP4 on vascular cells for wound healing under hypoxia insults. Methods and Results: Primary human dermal microvascular endothelial cells (HDMECs) and adipocytes were used. FABP4 and inflammatory protein expressions such as tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β were upregulated under the hypoxic conditions. Treatment with conditioned medium from adipocytes under the hypoxic conditions significantly impaired cell function including migration and tube formation abilities in HDMECs. Furthermore, FABP4 and inflammatory protein expressions were upregulated, and angiogenic signaling pathways such as phospho-AKT/hypoxia-inducible factor (HIF)-1α/vascular endothelial growth factor (VEGF)/ stromal cell-derived factor (SDF)-1 were downregulated in these conditioned medium treated HDMECs. Interestingly, administration of FABP4 inhibitor could reverse the conditioned medium-induced cell damages in HDMECs. On the other hand, FABP4 could directly impair cell functions with lower angiogenic and higher inflammatory protein expressions in HDMECs under the hypoxic conditions. Conclusions: Our pilot findings suggested that adipocyte hypoxia might lead to the secretion of inflammatory proteins and FABP4. Adipocyte-derived FABP4 could impair the migration and tube formation abilities of HDMECs via upregulating TNF-α/IL-6/IL-1β and downregulating phospho-AKT/HIF-1α/VEGF/SDF-1 signal pathways. Our findings provide a theoretical basis to the potential impact of FABP4 as a novel therapeutic target on wound healing in obese subjects with adipose tissue hypoxia.
Abstract 9399: Elevated MCU Expression by CaMKIIδB Limits Pathological Cardiac Remodeling
Authors: Pei Wang, Wang Wang
Journal: Circulation (2022)

Introduction: Calcium (Ca 2+ ) is a key regulator of energy metabolism. Impaired Ca 2+ homeostasis damages mitochondria, causing cardiomyocyte death, pathological hypertrophy, and heart failure. This study investigates the regulation and the role of the mitochondrial Ca 2+ uniporter (MCU) in chronic stress-induced pathological cardiac remodeling. Methods: MCU knockout or transgenic mice were infused with isoproterenol (ISO; 10 mg/kg per day, 4 weeks). Cardiac hypertrophy and remodeling were evaluated by echocardiography and histology. Primary cultured rodent adult cardiomyocytes were treated with ISO (100 nmol/L, 48 hours). Intracellular Ca 2+ handling and cell death pathways were monitored. Adenovirus-mediated gene manipulations were used in vitro. Results: Chronic administration of the β-adrenergic receptor agonist ISO increased the levels of the MCU and the MCU complex in cardiac mitochondria, raising mitochondrial Ca 2+ concentrations, in vivo and in vitro. ISO also upregulated MCU without affecting its regulatory proteins in adult cardiomyocytes. It is interesting that ISO-induced cardiac hypertrophy, fibrosis, contractile dysfunction, and cardiomyocyte death were exacerbated in global MCU knockout mice. Cardiomyocytes from knockout mice or overexpressing a dominant negative MCU exhibited defective intracellular Ca 2+ handling and activation of multiple cell death pathways. Conversely, cardiac-specific overexpression of MCU maintained intracellular Ca 2+ homeostasis and contractility, suppressed cell death, and prevented ISO-induced heart hypertrophy. ISO upregulated MCU expression through activation of Ca 2+ /calmodulin kinase II δB (CaMKIIδB) and promotion of its nuclear translocation via calcineurin-mediated dephosphorylation at serine 332. Nuclear CaMKIIδB phosphorylated CREB (cAMP-response element binding protein), which bound the Mcu promoter to enhance Mcu gene transcription. Conclusions: The β-adrenergic receptor/CaMKIIδB/CREB pathway upregulates Mcu gene expression in the heart. MCU upregulation is a compensatory mechanism that counteracts stress-induced pathological cardiac remodeling by preserving Ca2+ homeostasis and cardiomyocyte viability.
Abstract 274: Identifying Target Populations For Extracorporeal Cardiopulmonary Resuscitation Among Patients With Refractory Out-of-hospital Cardiac Arrest Using Machine Learning
Authors: Itsuki Osawa, Ichiro Hirayama, Mineji Hayakawa, Yuichi J Shimada, Kent Doi
Journal: Circulation (2022)

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) can be used on patients with out-of-hospital cardiac arrest (OHCA) when the cause is potentially reversible. However, little is known about the optimal target populations for ECPR among those with refractory OHCA. Methods: We retrospectively analyzed nationwide OHCA registry data on 57,754 patients from 93 hospitals in Japan, 2014-2019. We identified 1,273 patients having a witness or initially shockable rhythms with refractory OHCA of presumed cardiac origin without return of spontaneous circulation after &gt;3 doses of adrenaline administration and defibrillations when necessary at the emergency department (ED). We used the causal forest—a machine learning method to estimate heterogeneous treatment effects—to determine individual treatment effects of ECPR on a favorable 30-day neurologic outcome defined as the Cerebral Performance Category scale of 1 or 2, adjusting for confounders (e.g., age, sex, initial cardiac rhythms, and laboratory data). We compared patient characteristics in each quintile of individual ECPR effects to identify potential determinants of ECPR effects in patients with refractory OHCA. Finally, to determine optimal targets of ECPR, we evaluated how ECPR effects could vary depending on patient characteristics. Results: We found that the treatment effects of ECPR on a favorable neurologic outcome were heterogeneous (top 20% vs. others, 0.15 vs. 0.00; p&lt;0.001) ( Figure 1 ). The key determinants of ECPR effects were initial cardiac rhythms on the emergency medical service (EMS) and at ED arrival, regardless of EMS transport time or laboratory data. In addition, ECPR effects varied depending on the information on ED arrival (i.e., witness, bystander CPR, and initial cardiac rhythms) ( Figure 2 ). Conclusion: Among patients with refractory OHCA, information available on arrival at the ED could effectively identify patients who may particularly benefit from ECPR.
Abstract 9451: Association Between Hypertension and Incident Infective Endocarditis
Authors: Gyu B Lee, KOH EUN SHIN, Kyung-Do Han, Ho-Sung Son, Jae Seung Jung, Yang-Hyun Kim, Hee Jung KIM
Journal: Circulation (2022)

Introduction: This study aimed to evaluate the association of hypertension with incident infective endocarditis (IE) by investigating the incidence of IE according to blood pressure levels using the National Health Insurance Service database. Hypothesis: Considering the recent rise in the incidence of IE and the fact that little research has been conducted on the relationship between blood pressure levels and IE incidence, we hypothesized that hypertension may serve as a risk factor for incident IE. Methods: The data of 4080331 individuals linked to the health screening database in 2009 were retrieved (males, 55.08%; mean age 47.12 ± 14.13 years). From 2009 to 2018, the risk factors for the first episode of IE were investigated. Hypertension was categorized into normotension, prehypertension, hypertension, and hypertension with medication. The Cox proportional hazard model assessed the effect of blood pressure level during the health screening exam on incident IE. Results: During the 9-year follow-up, 812 (0.02%) participants were diagnosed with IE. The incidence rates of IE in the normotension, prehypertension, hypertension, and hypertension with medication groups were 0.9, 1.4, 2.6, and 6.0 per 100,000 person-years, respectively. Those with prehypertension, hypertension, and hypertension with medication were correlated with an increased risk of IE in a dose-response manner compared with the normotension group (hazard ratio, 1.33 [95% CI, 1.06-1.68]; hazard ratio, 1.98 [1.48-2.66]; hazard ratio, 2.56 [2.02-3.24], respectively, all P&lt;0.001). Conclusions: In a large national cohort study with an average follow-up of 9-years, increased blood pressure was identified as a risk factor for incident IE in a dose-dependent manner. Hypertension increases the public health care burden by acting as a risk factor for rare infective heart diseases.
Abstract 279: Ecpr, A New Source Of Organs
Authors: Alice Hutin, Alexandre BOURDIAULT, Jean Herle Raphalen, Thomas VALENTIN, Tal Soumagnac, Damien VIMPERE, Hatem Ammar, Christelle DAGRON, Kim An, Akshay MUNGUR, Pierre Carli, Lionel Lamhaut
Journal: Circulation (2022)

Purpose: The scarcity of renal grafts is a major public health problem. New strategies are sought to overcome the problem of organ shortage. Organ donation after brain death is a major source of renal grafts. In our center, extracorporeal cardiopulmonary resuscitation (ECPR) is used as a 2nd line of treatment for refractory cardiac arrest. Despite this treatment, some patients present brain death and become eligible to organ donation. To this day, information is scarce on the long-term outcome of renal grafts from these patients. The objective of this study was to evaluate this outcome. Methods: We conducted a monocentric retrospective observational study between 2011 and 2017. The study was validated by the local ethics committee. We included patients who were eligible to organ donation after diagnosis of brain death and from whom at least one organ graft was procured and transplanted. Among these patients we compared those who were treated by ECPR for refractory cardiac arrest (ECPR group) and those who were not (control group). Results: During the study period, 45 patients were included, respectively 23 and 22 in the control and ECPR groups. Patients from the ECPR group were younger with less comorbidities (respectively 41+/-13 vs 63+/-19 years in the ECPR and control groups, p&lt;0,044). However, they were more severe during their ICU stay, as shown by their SAPS II score which was significantly higher (80+/-13 vs 61+/-15 in the ECPR and control groups respectively, p&lt;0,001). A total of 68 renal grafts were procured, transplanted, and studied (34 in each group). There was no difference between the 2 groups in terms of graft survival at 1 year (94.1 vs 82.4% in the ECPR and control group respectively, p=0,52). Discussion-Conclusion: Our study outlines that kidneys harvested from patients treated with ECPR have similar long-term outcome to organs retrieved from patients developing brain death without ECPR. Younger age and absence of comorbidities seem to compensate patient severity after cardiac arrest. One could hypothesize on a protective effect of ECPR on kidney function due to continuous blood flow delivered in the descending aorta. With the increase of ECPR cases, this strategy could be an increasing source of organs to address the issue of organ shortage.
Abstract 9448: Pre-Stroke Statin Use is Associated With Mild Neurological Symptoms at the Onset of Acute Ischemic Stroke
Authors: Takahisa Mori, Kazuhiro Yoshioka, Yuichi Miyazaki
Journal: Circulation (2022)

Introduction: Statins have protective effects against ischemic injury, and pre-stroke statin use augments cerebral blood flow, reduces infarct size, and improves neurological function in mice. Hypothesis: Pre-stroke statin is associated with mild neurological symptoms at the onset of acute ischemic stroke (AIS). Methods: We retrospectively included patients with AIS admitted to our institution within 24 hours of onset between April 2011 and March 2019. We collected data on age, sex, pre-stroke use of stains, antiplatelets, anticoagulants, antihypertensive drugs, and diabetes drugs, the National Institutes of Health Stroke Scale (NIHSS) score, serum levels of albumin, glucose, glycated hemoglobin, lipids, and c-reactive protein, and stroke subtypes at admission. In addition, we defined mild neurological symptoms (mNS) as the NIHSS score of three or less. We compared variables between patients with and without pre-stroke statins and identified variables with significant differences between them. We conducted a logistic regression analysis using variables for pre-stroke statin use except for the NIHSS score, mNS, lipids, or stroke subtypes, calculated propensity scores for a pre-stroke statin and implemented a one-to-one propensity score matching (PSM). We evaluated differences between matched pairs and whether pre-stroke statin was significant for mNS at admission. We used the McNemar test to evaluate symmetry on a binary matched pairs contingency table of mNS. Results: Two thousand six hundred fifteen patients met our inclusion criteria during the study period. In 594 patients (22.7%) with pre-stroke statins and 2021 patients without them, 308 (51.9%) and 895 (44.3%) patients presented mNS (p=0.0012). After one-to-one PSM, 555 patients underwent pre-stroke statin treatment, and 555 patients did not undergo it. There were no differences in variables between matched pairs except for the NIHSS score, mNS, or cholesterol levels; 286 patients with pre-stroke stains and 252 patients without them presented mNS at admission (p=0.0411), and the binary matched pairs contingency table of mNS was not symmetrical (p=0.0385). Conclusions: Pre-stroke statin use is associated with mNS at the onset of AIS.
Abstract 9801: Late Onset Phrenic Nerve Injury Post PPM Placement
Authors: Mohammad As Sayaideh, Eldon L Matthia, Riley Jones
Journal: Circulation (2022)

Background: Transient phrenic nerve paralysis is a known immediate complication of cardiac implantable electronic device implants. Proposed mechanisms include direct nerve injury during venipuncture, nerve compression from a mediastinal hematoma, or local anesthetic instillation. However, the authors present a rare case of phrenic nerve injury as a late complication of permanent pacemaker (PPM) placement after excluding other etiologies. Case Summary: A 39 year-old female with a history of hypertension and diabetes underwent dual-chamber permanent pacemaker (PPM) placement due to sinus node dysfunction. She presented a year later with a subacute onset of progressive dyspnea on exertion that worsened over the four days prior to admission. Dyspnea was associated with right neck and shoulder pain. Chest radiography at presentation showed elevated right hemidiaphragm. A fluoroscopic sniff test confirmed right hemidiaphragm paralysis. Chest computed tomography revealed no anatomic abnormalities. Magnetic resonance imaging of the cervical spine showed no spinal cord or nerve root lesions. Electromyography confirmed right phrenic nerve injury as the etiology of elevated right hemidiaphragm. She continued to experience exertional dyspnea and orthopnea. Thoracic surgery scheduled the patient for insertion of a diaphragmatic pacemaker. She was discharged pending her surgery. Discussion: Late onset diaphragmatic paralysis due to phrenic nerve injury is a rare complication of PPM insertion. The mechanism of phrenic nerve injury from PPM insertion is unclear. It may result from direct or indirect phrenic nerve micro-injury by the relatively stiff pacemaker leads or peel-away introducers, resulting in slow Wallerian degeneration of the phrenic nerve fibers. In addition, microhematomas, undetected by chest computed tomography, inflammatory or thrombotic changes of the subclavian vein or the superior vena cava may influence the adjacent phrenic nerve.
Abstract 9696: Long-Term Outcomes With Abandoning versus Extracting Sterile Leads: A 10-Year Population-Based Study
Authors: Fahimeh Talaei, Min-Choon tan, Komandoor S Srivathsan, Dan Sorajja, Arturo M Valverde, Luis R Scott, Samuel Asirvatham, Fred Kusumoto, Siva K Mulpuru, Yong-Mei Cha, Justin Lee
Journal: Circulation (2022)

Background: Long-term outcomes of lead management strategies of lead abandonment (LA) or transvenous lead extraction (TLE) during cardiac implantable electronic devices (CIED) procedures requiring lead addition or replacement remain unclear. Hypothesis: We hypothesized that there is no difference in long-term (10-year) outcomes of LA versus TLE during CIED procedures requiring lead addition. Methods: We performed a retrospective cohort study of a population residing in seven adjacent counties of southeastern Minnesota with follow-up at the Mayo Clinic and its health systems. Patients who underwent LA or TLE for sterile leads from January 1, 2000, to January 1, 2011, and had follow-up for at least 10-years or until their death were included. Outcomes were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system. Results: A total of 172 patients were included in the study with 153 patients who underwent LA and 19 who underwent TLE for sterile leads. In long-term follow-up, indications for subsequent lead extraction arose in 9.1% (n=14) of patients with initial LA and 5.3% (n=1) in patients with initial TLE, after an average of 7-years. Moreover, out of 14 patients, who required secondary extraction in the LA cohort, 28.6% did not proceed with the extraction. Of the remaining 10 patients, 60% had clinical success and 40% had a clinical failure with the extraction. Subsequent device upgrades or revisions were performed in 18.3% of patients in the LA group and 31.6% in the TLE group, with no significant differences in procedural challenges such as requiring balloon venoplasty or serial dilation (5.2% vs. 5.3%, P=1.0). There was no difference in 10-year survival probability among LA group and TLE group (P=0.64). Conclusion: Indications for subsequent extraction arose in 9.1% of patients with the initial LA approach for sterile leads after an average of 7.3 years and 28.6% did not proceed with the extraction. Of the patients who underwent the subsequent extraction, 60% had clinical success and 40% had a clinical failure. There was no difference in 10-year survival probability between patients with the initial LA approach or TLE approach.